Adolescence is a time when mental health issues are common. Half of all lifetime mental health disorders emerge by age 14. Despite the majority of adolescents being seen every year in primary care, only a third of depressed teens are identified in the usual health visit without use of a screening tool. One in every twelve teens in rural New England at health visits screen at risk for depression or suicide. Evidence exists that a collaborative care system where teens are screened for depression, providers receive training and supports to assess teens, and office staff are trained to provide follow up and referral will lead to better outcomes. The US Preventive Services Task Force recommends this approach. However, most clinicians, especially in small rural practices, find it overwhelming to change usual care and lack resources to establish enhanced office care linked to mental health services. Linking clinicians through the practice research network has provided regional practices with the support to implement innovative changes to enhance patient care. Through AHRQ support the Dartmouth COOP Project and CECH Practice-Based Research Networks (PBRNs) will partner with Dartmouth Hitchcock and regional mental health key stakeholders to establish the structure to train clinicians and their office staff, enhance mental health counseling options, provide clinicians with adolescent psychiatric input, and support office changes to respond to teen depression. The Dartmouth COOP Project will provide the tools and staff to assist practices in quality improvement with the office and form an ongoing group of practices and stakeholders to sustain improvements in the delivery of primary care adolescent mental health services. PUBLIC HEALTH RELEVANCE: The proposed Teen Mental Health program addresses a major public health issue affecting youth. By ages 19-20 twenty-three percent (23%) of youth have had an episode of depression and suicide is nationally the 3rd leading cause of death for 15-24 year olds. Enhanced primary care screening and management can play an important role in prevention and early treatment.